Impact of invasive strategy for the management of patients with cardiogenic shock after acute myocardial infarction

Trends in acute myocardial infarction complicated by cardiogenic shock, 1979-2003, United States

BACKGROUND

Acute myocardial infarction (AMI) complicated by cardiogenic shock is associated with high morbidity and mortality.

METHODS

Using the National Hospital Discharge Survey data from 1979 to 2003, we measured trends in the incidence of AMI complicated by cardiogenic shock, the use of percutaneous transluminal coronary angioplasty (PTCA), and the inhospital death.

RESULTS

Age-adjusted hospitalization rates (per 100,000 populations) in 1979 and 2003, respectively, were 213 and 261 for AMI, and 8.6 and 4.3 for AMI complicated by cardiogenic shock. Among patients with AMI, the proportion with cardiogenic shock was 3.9% (n = 17,000) in 1979 and 1.7% (n = 13,000) in 2003. Patients with acute myocardial infarction with cardiogenic shock, compared with those without cardiogenic shock, were more likely to be women (48% vs 43%, P < .0001), more likely to have anterior wall AMI (33% vs 14%, P < .0001), and had much higher inhospital mortality (43% vs 7%, P < .0001). Over the years, among AMI complicated by cardiogenic shock, PTCA use increased substantially from 0% to 28%. During this period, inhospital death decreased from 84% to 43%. After adjustment for age, sex, location of AMI, health insurance, and survey year, PTCA use was significantly associated with decreased inhospital deaths among patients with AMI with cardiogenic shock.

CONCLUSIONS

Although hospitalization for AMI has increased over the past 25 years, the hospitalization rate of AMI complicated by cardiogenic shock has decreased by 50%. At the same time, PTCA use and hospital survival have increased substantially among cardiogenic shock patients.